老年脑梗塞急性期肺部感染证型分布及痰热壅肺证治疗的研究

发布时间：2018-03-11 04:27

本文选题：老年脑梗塞　切入点：肺部感染　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：老年脑梗塞急性期肺部感染中医证型分布组合繁多复杂,目前尚无统一标准,这不利于临床应用以及临床诊疗水平的提高。本研究目的：(1)探讨中医证型分布及演变规律,进行规范化和标准化研究,以期更好的指导临床应用。(2)选择证型分布最常见的证型(痰热壅肺证),开展中医辨证治疗,观察其临床疗效,评价辨证治疗的效果,并探求其作用机理,为临床推广应用提供临床依据。方法：(一)证型分布规律研究：采用前瞻性调查研究的方法,收集2014年3月～2015年4月间在广州中医药大学第一附属医院脑病中心颅脑科确诊的老年脑梗塞急性期肺部感染住院病人120例,采集一般情况、证素,概括证型转归等内容。(由经验丰富的3位医生同时对每位患者进行证素及证型判定,其结果的判定同时需要2位医师的认可才能成立。)收集患者入院第1天证素情况,分别统计第1-5天、6-10天、11～14天证型分布及最常见证型转化情况,并将结果填入设计好的调查表中,建立原始临床数据库后,将数据导入SPSS 19.0,对证素总体分布情况、证型分布情况进行频数统计,从而归纳总结出主要证型分布规律以及随着病程转化情况。(二)痰热壅肺证辨证治疗的研究：收集2015年5月～2016年1月间在广州中医药大学第一附属医院脑病中心颅脑科确诊为老年脑梗塞急性期肺部感染痰热壅肺证的在院病人60例,随机分为对照组和治疗组(在现代医学常规治疗基础上,口服或鼻饲清热化痰合剂,辨证加减通腑合剂、益气养阴合剂),每组30人。观察两组患者治疗前后中医症状积分、肺部感染症状体征评分、实验室生化指标(白细胞及降钙素原)变化情况；NIHSS评分(入院时、治疗前、治疗后)、肺部感染控制时间。验证清热化痰合剂(辨证加减通腑合剂、益气养阴合剂)治疗老年脑梗塞急性期肺部感染痰热壅肺证的临床疗效,并探求其作用机理。结果：(一)证型分布研究：1.老年脑梗塞急性期肺部感染的主要证型分布：痰热壅肺证(48.3%),气虚痰浊阻肺证(16.7%),阴阳两虚痰闭证(13.3%),气虚血瘀痰阻证(6.7%),瘀热蕴毒证(3.3%),气阴两虚证(3.3%)。痰热壅肺证为老年脑梗塞急性期肺部感染最常见的证型。2.痰热壅肺证58例患者在第6-10天期间有30例兼有腑实证,10例兼有气阴两虚证。在11-14天期间,腑实、气阴两虚证病例进一步增加,分别为32例,30例。(二)痰热壅肺证治疗的研究：1.治疗组在入院时患者NIHSS评分与治疗前NIHSS评分进行比较有显著性统计学差异(P0.05),对照组在入院时患者NIHSS评分与感染治疗前NIHSS评分进行比较也有显著性统计学差异(P0.05)。治疗组与对照组在治疗后NIHSS评分、治疗前后两组差值比较无明显统计学差异(P0.05)。2.治疗组与对照组在肺部感染控制时间相比有明显统计学差异(P0.05),两组患者在治疗后白细胞及降钙素原异常比较无明显统计学差异(P0.05),两组患者治疗期间死亡人数无明显统计学差异(P0.05)。3.治疗组与对照组在治疗后中医症候评分、治疗前后中医症候评分差值比较、治疗后肺部感染症状体征评分比较均有显著性统计学差异(P0.05)结论：(一)证型分布研究：1.老年脑梗塞急性期肺部感染证型分布主要有6种,依次为：痰热壅肺证,气虚痰浊阻肺证,阴阳两虚痰闭证,气虚血瘀痰阻证,瘀热蕴毒证,气阴两虚证。2.痰热壅肺证是老年脑梗塞急性期肺部感染最常见的证型,随着病程推移很多患者兼有腑实证、气阴两虚证。(二)痰热壅肺证治疗的研究：1.老年脑梗塞急性期肺部感染影响患者近期预后,增加患者死亡率,是加重患者病情独立危险因素。2.清热化痰合剂基础上辨证加用通腑、益气养阴合剂较单纯现代医学常规治疗可有效的控制肺部感染,减少肺部感染治疗时间。但急性期内对改善患者神经功能缺损症状与单纯现代医学常规治疗相比无明显差异。3.清热化痰合剂基础上辨证加用通腑、益气养阴合剂可改善中医临床症状,提高中医疗效。
[Abstract]:Objective: acute cerebral infarction in elderly pulmonary infection syndromes combination complex, at present there is no uniform standard, which is not conducive to the clinical application and improve the level of clinical diagnosis and treatment. The purpose of this study is: (1) to investigate the evolution and distribution of TCM syndrome type, research and standardization of norms, in order to better guide clinical application. (2) syndrome type selection of the most common syndromes (phlegm heat in the lung), in TCM treatment, observe the clinical curative effect evaluation, treatment effect, and to explore its mechanism, to provide clinical basis for the clinical application. Methods: (a) study on rule of Syndrome Distribution: methods a prospective study, from March 2014 to April 2015 in the First Affiliated Hospital of Guangzhou University of Chinese Medicine encephalopathy diagnosed senile cerebral infarct in acute stage of pulmonary infection in hospitalized patients in 120 cases, collected in general, Summarize the contents of syndrome elements, syndrome type of outcome. (to recognized by 3 doctors experienced at the same time for each patient the syndrome and syndrome type determination, determine the results of the 2 physicians also need to set up.) were collected on the first day syndrome, the statistics were 1-5 days, 6-10 days, 11~14 day card type distribution and the most common syndrome type transformation, and results in the designed questionnaire, establish the original clinical database, import data into SPSS 19, the overall distribution of syndrome elements, frequency statistical distribution of syndromes, we summarized the main syndromes distribution and transformation (with the course of disease. Two) on the treatment of phlegm heat obstructing lung syndrome: from May 2015 to January 2016 in the center of the First Affiliated Hospital of Guangzhou University of Chinese Medicine encephalopathy were diagnosed as cerebral lung phlegm heat syndrome of senile cerebral infarction in acute stage of pulmonary infection in hospital 60 patients were randomly divided into control group and treatment group (on the basis of modern medicine conventional therapy, oral or nasal feeding phlegm mixture, syndrome differentiation and Tongfu mixture, supplementing qi and nourishing Yin mixture), each group of 30 people. Two groups were observed before and after treatment in patients with symptoms and signs of TCM symptom score, pulmonary infection score, biochemical indexes (the white blood cell and procalcitonin (NIHSS) changes; score on admission, before treatment, after treatment), pulmonary infection control time. Verify the phlegm mixture (prescription of Tongfu mixture, Yiqi Yangyin mixture) clinical efficacy of the treatment of phlegm heat in the lung of senile cerebral infarction in acute stage of pulmonary infection, and to explore its mechanism. Results: (a) the distribution of Syndrome Distribution: 1. main syndromes of pulmonary infection in elderly acute cerebral infarction: phlegm heat in the lung (48.3%), Qi deficiency and phlegm obstructing lung and syndrome of deficiency of yin and Yang (16.7%), two (13.3%), phlegm syndrome of qi deficiency and blood stasis phlegm Card (6.7%), blood stasis and heat toxin syndrome (3.3%), two Qi and yin deficiency syndrome (3.3%). Lung phlegm heat syndrome is the most common type of.2. lung phlegm heat syndrome of senile cerebral infarction in acute stage of pulmonary infection in 58 patients in the first 6-10 days during the 30 cases with positive organs, 10 cases with two Qi and yin deficiency syndrome. In the period of 11-14 days, constipation, further increasing Qi and yin deficiency syndrome with two cases, 32 cases respectively, 30 cases (two). Study on the treatment of phlegm heat in the lung in the treatment group: 1. patients on admission NIHSS score and NIHSS score before treatment were compared with significant statistical differences (P0.05 in the control group), admission NIHSS score of patients with NIHSS infection before treatment were compared with significant statistical differences (P0.05). The treatment group and the control group after treatment NIHSS score before and after treatment, the difference between the two groups is no significant difference (P0.05).2. treatment group and control group in pulmonary infection control the time had significant compared No statistical difference (P0.05), after treatment in two groups of white blood cells and procalcitonin abnormalities is no significant difference (P0.05), two groups of patients during treatment with the death toll has no obvious statistical difference (P0.05).3. in treatment group and control group after treatment of TCM syndrome score, TCM symptom score before and after treatment treatment comparison of symptoms and signs of pulmonary infection after treatment scores were significantly statistical difference (P0.05) conclusion: (a) the distribution of syndromes: 1. senile acute cerebral infarction pulmonary infection syndromes mainly have 6 kinds, were: Qi deficiency and phlegm heat in the lung, phlegm obstructing lung and syndrome of deficiency of Yin and Yang, phlegm two closed card, blood stasis and sputum, blood stasis heat toxin syndrome, Qi Yin deficiency two.2. syndrome of phlegm heat obstructing lung syndrome is the most common in elderly cerebral infarction in acute stage of pulmonary infection, with the course of time many empirical patients with Fu, two Qi and yin deficiency syndrome (two). The treatment of phlegm heat obstructing the lung The study: the impact of short-term prognosis in patients with acute cerebral infarction in 1. elderly patients with pulmonary infection, increased mortality, increase the patient's condition is an independent risk factor of.2. mixture on the basis of syndrome differentiation of phlegm with Tongfu, invigorating qi and nourishing Yin mixture compared with modern medicine conventional therapy can effectively control lung infection, reduce the treatment time but acute lung infection. In the improvement of patients with neurological symptoms and simple modern medicine conventional therapy showed no significant difference.3. mixture on the basis of syndrome differentiation of phlegm with Tongfu, invigorating qi and nourishing Yin mixture can improve clinical symptoms, improve the therapeutic effect of traditional Chinese medicine.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R277.7

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